Individual
KYWNYNN MADSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
Mailing address
PO BOX 76, RIGBY, ID 83442-0076
(208) 589-3054
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86039670
ID
Other
Enumeration date
03/31/2020
Last updated
03/31/2020
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